Categories

Meta

Thoughts on Clinical Depression in Contemporary Life

Those who deal with mental illness, or really any chronic illness, whether as sufferers or caretakers throw around the term “coping” often. “How are you coping?” or “What are your coping strategies?” are questions I think every mental health care provider I’ve met has asked me. But there are different levels of coping. For instance I’m coping right now because I’m writing and I’m doing household chores and I’m not a complete puddle of tear-stained numbness. I’m not suicidal or self-harming, but that doesn’t mean I’m effectively managing my depression. I’m not working currently and feel overwhelmed with panic at how to take the steps forward to professional fulfillment. Right now my full-time job is employing coping strategies. But if those coping methods only work in getting me to wake up and repeat the next day, are they effective? How do we measure the efficacy of coping strategies and what does it mean if they don’t help a person be fully functional?

Anxiety feels like a rebuttal of Newton’s laws of motion. Simultaneously I want with all my body to act, to move, to do something, but also I feel frozen with inertia, completely shut down. I’m neither at rest nor in motion. I’m abuzz with immobility.

When I think of films that have really captured the experience of depression, Groundhog Day is at the top of the list. It’s not meant to be about depression as far as I know. The main character, Phil played by Bill Murray, does get depressed as a result of his circumstances. Yet its the very circumstances that feel like a metaphor for depression not that the cause of it. Being trapped in the same day indefinitely and feeling as if any action you take is ineffectual resonates with me. Every night I go to bed and hope that tomorrow will be more productive, or that I will finally stumble upon the compass to righting my neurological course. I’m confined by forces that I don’t understand and have no control over so I just keep going day after day after day, adjusting my actions to make my experience a teeny bit better but with little hope of a breakthrough. Some nights I wonder whether I can make it one more day, but I wake up the next day and start the process anew. And at the end of a depressive episode, it really is like waking up to what seemed a tomorrow forever in the distance. While I have yet to be able to take up the piano or fall in love during a depression, the first two-thirds of that film mirror the reality of depression.

I’ve been thinking of how place becomes entangled with our mood. Being in a bad state of mind is so often blamed on just being in the wrong state. In grad school I’ve heard many people complain about how badly they want to leave the city we’re our program is in. Yet when you ask them to pin down exactly what they hate about this city they come up with a million vague reasons, half of which contradict the other half. Qualities I’ve heard them disparage for our city having, they praise other towns for having. Eventually they admit that maybe they just are frustrated with grad school, but it’s easier to blame a city for your misery than your own choice to pursue a career. No one wants to admit that their dream or their goals are causing them intense pain. It’s easier to move than it is to change life paths.

I remember hating the city I lived in my first year of college. I blamed the change of location for my frustration with college, but really the source of my discontent was more complicated than my geographic coordinates. I grew to love that city and came to the conclusion I’d probably be happy in any mid to large-sized city, as long as I was already happy.

Currently I seem to hate all of the cities I have ties to, because they remind me of myself too much. It’s why staycations just aren’t as refreshing as travel. In a new place we can get distance from all of our problems. If we lived in our travel destinations, though, they’d quickly lose their allure as they became part of our own personal history. We love places that are part of our past because of nostalgia, and places that are new because they represent unblemished futures. Places of now can feel like home or like a prison when we are confined by our minds. Once we acknowledge that, it is easier to do renovations on ourselves and feel happy at home.

When you are depressed, everything feels like chaos. Simple morning routines like replying to emails and commuting to work become completely unmanageable. Your mind’s ability to sort through irrelevant details and focus on priorities vanishes into thin air. You become exhausted from trying to sift through the chaos of everyday life. This exhaustion only begets more chaos as you let things slide and your routines, your tethers to mental stability slip away. Worried messages fill your voicemail. You’ve lost control and are now at the mercy of the unpredictable winds of change within your mind. You are desperate for a moment of quiet during the storm.

Like this:

I’ve lost entire years of my life to depression. Like cats, those who deal with severe depression live nine lives or more, because each episode becomes a kind of death. When you stop going to work, school, social functions, etc. eventually your world adapts to being without you. At first your friends and family reach out, but eventually they move on because that is what life is: moving on from the past.

Someone under the weight of depression is a ghost from the past. Occasionally they remind their loved ones of their presence. Their presence is ephemeral, however, not one that has any real impact or meaning on those it haunts.

So as a depressed person, you are a ghost watching a world you once felt as if you were an integral part. Now you struggle to remember what being alive felt like. Being vibrant, having plans, or feeling joy and love is alien to you, but like a ghost you linger on contemplating your unfinished business. There must be some reason you are still here.

Eventually you recall and leave your haunting grounds to become a live person again. Often you have to rebuild your world from scratch; A new job, new friends, new you. Except the part of you that was a ghost now haunts not your old world, but the new you. You’ve been reborn, but you still have memories of being the living dead and can never fully escape the dread of returning to purgatory.

Part of me is convinced that which we label depression is actually an array of distinct mental illnesses. There is a difference between depressions which are caused by tragic events such as the death of a loved one and depressions that just happen for no discernible reason. Depression manifests itself in so many ways that even two severely depressed people can have trouble understanding the other’s illness. But then part of me also sees how my own depression can morph.

There are two distinct phases of my depression. The most disruptive and most challenging for outsiders to comprehend is less immediately painful for me. Its marked by apathy and exhaustion. It’s the introverted sibling. I know on some level I want to be less tired and to go live my life, but I’m so entranced by the need to get more sleep or at least more quiet time with my eyes closed. I have trouble even getting out of bed to brush my teeth. Everything bores me and I can’t make a decision to save my life, figuratively and literally. I can’t make the decision to reach out and get help, and I can’t decide what to watch on Netflix next. Any tiny thing I accomplish like making coffee feels like I just completed a marathon; I’m worn out but also feel accomplished. I hardly ever cry or get angry during these periods. Sometimes I’ll think about suicide, but in a disinterested manner. It’s more of an academic question: What’s the point of going on if all I really want is to be alone in a dark room? I can remind myself that I have experienced joy and love and eventually I will again and that’s why I need to keep marching on, even if for now it’s marching in place. But really I can’t make a choice so inertia makes one for me.

The twin to this phase is more extroverted and energetic. I want to see friends and fill my days with activity, but I’m also prone to crying jags that last days. Every time I decide to call someone I’m filled with self-hatred or pity or anger, convinced that my nearest and dearest don’t want to hear from me or that the conversation will cause me pain. Or I think about eventually one of us will die and that will make the other sad and I live out that pain before it happens. Every movie I watch reminds me of something terrible I did or someone did to me, or someone did to someone I don’t even know, and how dark the world can be. I’m filled with anxiety about how long I can feel so terribly, and am desperate for this constant sense of my heart breaking to go away. Yet I can find solace in the fact that despite how much more wretched I feel, this is actually the less severe phase. I want to feel different on every level, not just intellectually. But feeling different, or rather normal, seems so alien to me. When I think of suicide during this phase, it becomes more palpable. I become certain I can’t survive a lifetime living this way and disbelieve that I can be not depressed again. All I see are obstacles. But then I see my marching has actually started to cover some ground, albeit slowly. This is what I need to focus on until I forget I’m marching at all.

They feel so different, but they come from the same source. They are both mothered by my dysfunctional brain.

My worst symptom is fatigue. Even after sleeping twenty hours I wake up feeling exhausted. Routines that most people take for granted, such as getting coffee and brushing my teeth are major hurdles. I go get my oatmeal and coffee and then have to take a rest before I can eat it. Getting out of bed to get water is another exertion of energy. Even taking my medications feels like a major task. Often, once I just get through these few simple things, I need to take a nap before I even think of showering.

And these are all things that I want, even enjoy, to do. So imagine how difficult it is to do the things that cause anxiety or stress when very basic things you either like or have no negative feeling towards are akin to running a marathon to someone who a running neophyte. All the tiny things one does without conscious effort during a day just deplete a depressed person’s energy when they don’t have any to spare.

I just stumbled across this story about the “Suffering the Silence” project. A lyme disease sufferer, who has a book coming out this fall about dealing with chronic illness, started the project. To encourage conversation about living with chronic illness, she and other sufferers have been posting portraits of themselves covering their mouths and having their illness written out across their arms. I think it’s a good idea to bring together sufferers of all sorts of illnesses together. Symptoms might be far-ranging, but I imagine no matter what the diagnosis a lot of the same life complications make living with illness a challenge whether you have diabetes or lupus or depression. I glanced through the hashtag on instagram, and unfortunately I didn’t see anyone with depression written out on their arm. There were two people who listed bipolar and anxiety along with other illnesses, but no one bared an arm with only mental illness on it. There are probably plenty of other illnesses missing, but I wonder if there is more to the lack of representation for a common affliction other than chance.

Obviously, many sufferers of depression don’t like to come out of the closet, so to speak. No matter how many articles there are online about what to say to depression sufferers, anyone who has dealt with it knows plenty of people, even well-meaning people judge depression. They think we’re weak or lazy or oversensitive. Or sometimes, they seem fully understanding of you and your illness, but make a throwaway comment that belies their encouragement… Even though most of the people in my life know my diagnosis, I still don’t want to identify myself online and have my name and my illness permanently connected for when future employers or first dates google me… I hope someone is brave enough though to post a portrait with their depression diagnosis emblazoned on them, because I think that might help fight the second reason there are so few mental illness sufferers on the project:

Despite the chronic nature of mental illness for many, if not most sufferers, people don’t think of it as the same thing as other illnesses. This goes back to the issue of seeing mental illness as a type of physical illness. Because so many of the symptoms affect aspects of what makes us who we think we are, it’s hard to appreciate it as akin to other ailments. It gets to whether there is free will and how do we understand people. If an illness can change someone’s personality so much how can we judge anyone? Who is good and who is bad? If genes and nutrition and other factors can influence the mind, can we take any ownership of who we are? We praise people for their will power and how hard-working they are. We are proud of our empathy and our creativity, but mental illness demonstrates that we only have a limited amount of control on who we are. I think, unconsciously, people are afraid to truly accept how much mental illness has in common with other illnesses because to navigate life we need to feel ownership and authorship over our minds.

The mind-body relationship can be discussed much more, and hopefully I will, but now back to my original point; I think it’s great that someone is making it easier for chronically ill people of all sorts to come together and recognize that not only do we have a community of people who share our diagnosis, but that there is an even wider community of people dealing with the same struggles that can be a support network.

On my worst days, I remind myself that just like a cold, the only thing I can do is hide in bed and make sure to get some fluids. These are the days I worry I’ll never get better, especially if I can’t take the supposedly simple steps towards getting better. But I’ve been through this long enough to know that if I just accept how crappy I feel, in a few days or maybe a week or so, I’ll be able to take those steps, slowly. Just like a cold, there’s no way to make it better other than time.

Unlike a cold, though, people don’t appreciate that it might take some time. They lecture you on all the steps you should be taking to get better, as if you weren’t aware, and only exacerbate your symptoms.

And while some people have strong immune systems and go years without colds, there are those of us who, no matter what steps we take to be healthy, get that pesky cold bug several times a year.